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Week of October 18, 2010

Life-saving researcher 
to receive Francis medal

Dr. Alfred Sommer remembers well his self-described “Holy cow!” moment, when his observational study on vitamin A deficiencies in poor children in Indonesia and the subsequent effect on eyesight revealed a shocking finding.

It was the Christmas season 1982, and his workdays, which included teaching and eye surgery, had slowed. This gave him more time to evaluate research findings from the 1976-79 research project that involved 4,000 children.

“I wanted to re-examine why some became vitamin A deficient and developed night blindness and other ocular abnormalities, while other children didn’t,” says Sommer, who will receive the Thomas Francis Jr. Medal in Global Public Health from U-M. He is professor of epidemiology, international health and ophthalmology at the Bloomberg School of Public Health and the Johns Hopkins University School of Medicine.

“It suddenly occurred to me that many of the children who started out with night blindness did not appear at their next scheduled examination, three months later,” he says. The realization was that many had died.

“It suggested that vitamin A status was related to the risk of childhood death in a very significant way,” says Sommer, whose career and work in Nepal are featured in the documentary films “The A Factor,” produced for UNICEF, and the “RX for Survival: A Global Health Challenge” series from PBS.

Photo courtesy Dr. Alfred Sommer.

Parallel studies Sommer organized with colleagues in Africa showed that most cases of measles-associated pediatric blindness, and half of all deaths, also were related to low vitamin A levels. Sommer and his colleagues ran large-scale randomized trials from 1983-92 and demonstrated the link between even mild vitamin A deficiency and pediatric mortality.

After wide acceptance by the scientific community of Sommer’s research findings, UNICEF estimates today that vitamin A supplement programs implemented in 70 countries save 350,000 lives a year — more than 1 million to date — and have saved even more children from blindness.

U-M will award the Francis Medal to Sommer in a public ceremony from 2-4 p.m. Nov. 4 in the Stephen M. Ross School of Business Blau Auditorium. Sommer will offer an address titled “Vitamin A Deficiency, Health and Mortality.”

A panel discussion will follow that addresses policy issues, implementation strategies and the challenges of advocacy with regard to vitamin A supplementation. Panelists include Anil Deolalikar, professor of economics and associate dean, social sciences and co-director of the One Health Center, University of California Global Health Institute; Kathy Spahn, president and CEO, Helen Keller International; and Eduardo Villamor, associate professor of environmental health sciences and epidemiology, U-M School of Public Health. Highlights from “The A Factor” will be shown at the event that is sponsored by the Board of Regents, the Office of the President, the School of Public Health and the U-M Center for Global Health.

One of the highest honors bestowed by U-M, the medal is named for Dr. Thomas Francis Jr., one of the university’s most distinguished scientists and public health heroes.

Francis, a physician and epidemiologist at U-M, designed and led the massive Salk polio vaccine field trial involving 1.8 million children that led to his announcement from Rackham Auditorium on April 12, 1955, that the Salk vaccine was safe and effective. The vaccine was developed by Jonas Salk at the University of Pittsburgh, who had studied under Francis.

The Francis Medal recipient is chosen based on major scientific contributions or inventions, public health policy leadership or other service that advances the world public health.

Sommer says those seeking to promote vitamin A intake by poor children and pregnant mothers — many of whom experience night blindness due to the deficiency — also have sought to promote consumption of foods rich in vitamin A.

Vitamin A is present in eggs, dairy products and liver. Sommer says that foods rich in beta carotene, including green leafy vegetables, are converted by the body to vitamin A when eaten.

Still, he points out that these foods aren’t always readily available, and their conversion to vitamin A isn’t as efficient as traditionally thought. In contrast, the large-dose capsules need only be given to a child twice a year, and each capsule costs only two cents.

Today, the World Health Organization and UNICEF help countries around the world to design and implement vitamin A-supplement programs. Some countries, like India, provide the vitamin A as a teaspoon of syrup rather than as a capsule, Sommer says.

“More than 50 countries are reaching over 80 percent of their target children at least once a year, and over 40 countries are reaching 80 percent of the target children twice a year,” Sommer says.

He adds that the World Bank and Copenhagen Consensus Center consider vitamin A supplementation one of the most cost-effective of all health interventions; one economic study suggesting it costs just $23 for each death averted. Sommer says the Canadian government is a leader in helping to fund the efforts to provide supplements, along with the United States and Great Britain.

The Thomas Francis Jr. Medal ceremony closely follows the 50th anniversary celebrations of John F. Kennedy’s announcement of the idea for the Peace Corps on the steps of the Michigan Union. While still in medical school, Sommer and his wife were accepted for Peace Corps service, but a position at the Centers for Disease Control and Prevention in Atlanta became available, and Sommer accepted an assignment to the Cholera Research Laboratory (now ICDDRB) in Dhaka, Bangladesh, where he conducted groundbreaking epidemiologic investigations.

He credits the Peace Corps for fueling his initial desire to work overseas in public health. Today, Peace Corps volunteers are involved in the administration of vitamin A to children around the world, and he often advises those working in the field.

Sommer continues to study the benefits of vitamin A and other micronutrients to reduce newborn mortality and mothers’ risk of dying. For pregnant mothers, he says, small weekly doses of vitamin A are preferred over the larger doses typically given to children, as larger doses can cause congenital defects.

“We were able to reduce the mothers risk of dying by 50 percent in Nepal. And giving vitamin A at birth reduces newborn mortality during the first couple months of life by 20 percent,” Sommer says. “We continue to do that work and help others to do that work.”



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